Homestead_Humphrey MATE FOKM:Wt. L'/vent IPF.IN[ER FORM 111A
.AnitnvEO BY'Lot[WNW Or ACTUM,.9n PPIS(AIBFD BY nir DEPARTNEYT OF 1(5A1 LOCA1GOBTLYMENT FINANCE r 6-I.1-r4.t
Gibson. .unty Auditor
101 f;fMain
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more iracmtree than net'for homestead fraud.Homestead fraud cause`higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Humphrey, Jeremiah/Tammy
RI Box III Q-.*
Oakland City IN 47660
1825
Jeremiah/Tammy Humphrey
R1 Box 111 State Parcel Number Leflal Description
Oakland City IN 47660-8506
11111111111111111111111111111111111111 I I I I I I 11111 002-00675-00 PT W NW 28 2 9 .954 AC
tan rru r u ta — _— _ /t__ C'_—_— __
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I �� First Middle Last
�J( /G/h1uh Vmpkr
rag Address(number and street.city,state,and ZIP code) 2 Same as property adds ,o 9 1)
24 fi
t"
a � S. � opt a(
Spouse First Middle Last
ten Ifu pk'ry
Mailing Address(Number and street,city,stile.and ZIP code) ® Same as property address
2 6 7 7y'
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
•
,,. CLAIM FOR HOMESTEAD PROPERTY TAX
a� 4 CREDIT /STANDARD DEDUCTION
Y 1 State Form 5473 (13215 -92)
rn.
INSTRUCTIONS: See reverse side for filing instructions.
,
' : CgRIPFICATI
[:FORM YEAR
HC10
PILE, I .
, rt i
I ( I 1 1 -f f )(4 f / certi at on the 1 st daK?f March, 19�
c
I (We) o upied as our principal place of residence the follovn g described rea property for ich a omestea P Tax- Credi(is hereby, claimed
' 1 (We) owned El Are buying under contract GIBS0 N U_r;;
U Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
_.:. CONTRACT RECORDED'.-. { --
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
/ J
- ASSESSOR USE ONLY -
PROPERTY DESCRIPTION
"ship)
Count
Township
Township
Taxing district (' own, t0
Parcel number
coa- 006750Q
Legal descri tion
d -a sV //tc
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
(2)
-s
/ J
- ASSESSOR USE ONLY -
• - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
HOMESTEAD
VALUE
Township
County
Township
I hereby
certify the above statements are true, correct and complete.
Signature of cl ' ant
Other land
(2)
-s
Total land (line I plus line Z)
7-77
tuber and street, u , state. ZIP code)
ll Al, d
//
i
/ J
- ASSESSOR USE ONLY -
TRUE TAX
VALUE.
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
a ure of udi r I
Other land
(2)
Total land (line I plus line Z)
(3)
Residential improvements
Dwelling
(4)
-,
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line b)
(7)
Total value (line 3 pfrs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Dare signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE'- -
19 _ Pay 19
Lesser of 1l2 Homestead
S
Valuation or $2,000
a ure of udi r I
Date sgn